护士主导的液体反应性监测方案对预防脓毒性休克患者液体积聚综合征的效果研究

doi:10.3761/j.issn.0254-1769.2025.16.006

摘要/Abstract

摘要：

目的构建护士主导的液体反应性监测方案，探讨其在脓毒性休克患者液体积聚综合征预防中的应用效果。方法通过文献回顾和专家会议，制订护士主导的液体反应性动态监测方案。采用便利抽样法，选取浙江省杭州市某三级甲等医院急诊科收治的脓毒性休克患者160例作为研究对象，按入院时间将2023年11月—2024年8月收治的80例脓毒性休克患者作为试验组，2023年1—10月收治的80例脓毒性休克患者作为对照组。试验组在常规护理基础上实施护士主导的液体反应性动态监测方案，对照组采用常规护理和液体反应性监测。比较两组干预效果及并发症发生率。结果试验组与对照组各80例完成研究。相较于对照组试验组液体复苏6、24 h乳酸清除率升高、急性肺水肿和液体积聚综合征发生率下降、机械通气时长和ICU住院时长缩短（均P<0.05）。两组28 d病死率差异无统计学意义（P=0.212）。结论该研究构建的护士主导的液体反应性监测方案具有科学性及实用性，实施该方案可有效提高脓毒性休克患者的乳酸清除率，降低液体积聚综合征及急性肺水肿的发生率，缩短机械通气和ICU住院时长。

关键词: 护士, 脓毒性休克, 血管容量, 液体积聚综合征, 危重病护理

Abstract:

Objective To develop a nurse-led dynamic monitoring protocol for fluid responsiveness and to evaluate its effectiveness in preventing fluid accumulation syndrome in patients with septic shock. Methods A nurse-led dynamic monitoring protocol for fluid responsiveness was developed through literature review and expert panel discussion. Using convenience sampling，160 patients with septic shock admitted to the emergency department of a tertiary hospital in Hangzhou，Zhejiang Province，were enrolled. According to admission period，80 patients admitted from November 2023 to August 2024 were assigned to an intervention group，and 80 patients admitted from January 2023 to October 2023 were assigned to a control group. The intervention group received the nurse-led dynamic monitoring in addition to routine care，while the control group received routine care and conventional fluid responsiveness monitoring. The therapeutic outcomes and incidence of complications were compared between the 2 groups. Results All 80 patients in each group completed the study. The intervention group demonstrated higher lactate clearance rates at 6 and 24 hours after fluid resuscitation，lower incidences of acute pulmonary edema and fluid accumulation syndrome，and shortened durations of mechanical ventilation and ICU stay（all P<0.05） compared to the control group. There was no statistically significant difference in 28-day mortality between the 2 groups（P=0.212）. Conclusion The nurse-led dynamic monitoring protocol for fluid responsiveness in patients with septic shock is both scientific and practical. Its implementation can effectively improve lactate clearance，reduce the incidence of fluid accumulation syndrome and acute pulmonary edema，and shorten the duration of mechanical ventilation and ICU stay.

Key words: Nurse, Septic Shock, Blood Volume, Fluid Accumulation Syndrome, Critical Care Nursing

叶丽霞, 许烨, 李琴, 计可欣, 周虹. 护士主导的液体反应性监测方案对预防脓毒性休克患者液体积聚综合征的效果研究[J]. 中华护理杂志, 2025, 60(16): 1959-1965.

YE Lixia, XU Ye, LI Qin, JI Kexin, ZHOU Hong. Effect of a nurse-led fluid responsiveness monitoring protocol in preventing fluid accumulation syndrome in patients with septic shock[J]. Chinese Journal of Nursing, 2025, 60(16): 1959-1965.

图/表 3

图1 护士主导的液体反应性监测方案框架

Figure 1 Nurse-led dynamic fluid responsiveness monitoring protocol 注：1 mmHg=0.133 kPa。

表1 两组一般资料的比较

Table 1 Comparison of baseline characteristics between the 2 groups

表2 两组干预效果的比较

Table 2 Comparison of intervention effects between the 2 groups

参考文献 24

[1]	Malbrain M, Martin G, Ostermann M. Everything you need to know about deresuscitation[J]. Intensive Care Med, 2022, 48(12):1781-1786. DOI PMID
[2]	Pfortmueller CA, Dabrowski W, Wise R, et al. Fluid accumulation syndrome in sepsis and septic shock:pathophysiology,relevance and treatment-a comprehensive review[J]. Ann Intensive Care, 2024, 14(1):115. DOI PMID
[3]	Douglas IS, Alapat PM, Corl KA, et al. Fluid response evalua-tion in sepsis hypotension and shock:a randomized clinical trial[J]. Chest, 2020, 158(4):1431-1445. DOI PMID
[4]	宁中兴. 重症超声与PiCCO指导脓毒症液体复苏效果对比研究[D]. 百色: 右江民族医学院, 2021.
	Ning ZX. Comparative study of critical care ultrasound and PiCCO in guiding fluid resuscitation of sepsis[D]. Baise: Youjiang Medical University for Nationalities, 2021.
[5]	曹岚, 张丽娜, 王小亭, 等. 重症护理超声专家共识[J]. 中华现代护理杂志, 2020, 26(33):4577-4590.
	Cao L, Zhang LN, Wang XT, et al. Expert consensus on intensive care ultrasound[J]. Chin J Mod Nurs, 2020, 26(33):4577-4590.
[6]	Zhao Z, Zhang Z, Liu J, et al. Supine transfer test-induced changes in cardiac index predict fluid responsiveness in patients without intra-abdominal hypertension[J]. BMC Anesthesiol, 2023, 23(1):318. DOI PMID
[7]	周晓瑜, 潘政雯, 方珍珍, 等. 1例Ⅳ度骨髓抑制患者并发脓毒症性休克的护理[J]. 中华护理杂志, 2023, 58(13):1635-1639. DOI
	Zhou XY, Pan ZW, Fang ZZ, et al. Nursing care of a patient with grade IV myelosuppression complicated with septic shock[J]. Chin J Nurs, 2023, 58(13):1635-1639.
[8]	周润奭, 崔娜, 隆云, 等. 2种心排量监测方法在重症感染性休克患者中的应用[J]. 中华护理杂志, 2020, 55(8):1181-1184. DOI
	Zhou RS, Cui N, Long Y, et al. Application of 2 cardiac output monitoring in patients with severe septic shock[J]. Chin J Nurs, 2020, 55(8):1181-1184. DOI
[9]	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315(8):801-810.
[10]	姚岚, 蒋沁娟, 熊文芳, 等. 脓毒症休克患者液体复苏中ICON和重症超声的应用效果:一项前瞻性随机对照研究[J]. 检验医学与临床, 2025, 22(2):210-215,222.
	Yao L, Jiang QJ, Xiong WF, et al. Application effect of ICON and critical ultrasound in fluid resuscitation for patients with septic shock:a prospective randomized controlled study[J]. Lab Med Clin, 2025, 22(2):210-215,222.
[11]	Rehn M, Chew MS, Olkkola KT, et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock in adults 2021-endorsement by the Scandinavian society of anaesthesiology and intensive care medicine[J]. Acta Anaesthesiol Scand, 2022, 66(5):634-635.
[12]	中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学, 2018, 38(9):741-756.
	Chinese Society of Emergency Physicians, Shock and Sepsis Committee of Chinese Research Hospital Association. Chinese guidelines for emergency treatment of sepsis/septic shock (2018)[J]. Chin J Crit Care, 2018, 38(9):741-756.
[13]	张青, 刘丽霞, 霍焱, 等. 重症超声在重症相关操作中应用专家共识[J]. 中华内科杂志, 2024, 63(5):439-461.
	Zhang Q, Liu LX, Huo Y, et al. Expert consensus on the appli-cation of critical care ultrasonography in invasive procedures[J]. Chin J Intern Med, 2024, 63(5):439-461. DOI PMID
[14]	中华医学会急诊医学分会, 中国医师协会急诊医师分会, 中国人民解放军急救医学专业委员会, 等. 脓毒症液体治疗急诊专家共识[J]. 中华急诊医学杂志, 2018, 27(1):30-38.
	Emergency Medicine Branch of Chinese Medical Association, Emergency Physicians Branch of Chinese Medical Doctor Association, Emergency Medicine Professional Committee of PLA, et al. Expert consensus on emergency fluid therapy for sepsis[J]. Chin J Emerg Med, 2018, 27(1):30-38.
[15]	Elwan MH, Roshdy A, Elsharkawy EM, et al. Can passive leg raise predict the response to fluid resuscitation in ED?[J]. BMC Emerg Med, 2022, 22(1):172. DOI PMID
[16]	张琳, 朱永胜. 肺部超声的临床应用及进展[J]. 临床超声医学杂志, 2021, 23(2):142-144.
	Zhang L, Zhu YS. Clinical application and advances in lung ultrasound[J]. J Clin Ultrasound Med, 2021, 23(2):142-144.
[17]	Di Nicolò P, Tavazzi G, Nannoni L, et al. Inferior vena cava ultrasonography for volume status evaluation:an intriguing promise never fulfilled[J]. J Clin Med, 2023, 12(6):2217.
[18]	金艳鸿, 孙红, 李春燕, 等. 《成人动脉血气分析临床操作实践标准(第二版)》解读[J]. 中国护理管理, 2022, 22(11):1601-1606.
	Jin YH, Sun H, Li CY, et al. Interpretation of clinical practice standards for arterial blood gas analysis in adults,second edi-tion[J]. Chin Nurs Manag, 2022, 22(11):1601-1606.
[19]	何方凯, 管小俊, 朱晔涵. 急性肺水肿的临床研究和诊疗策略[J]. 国际呼吸杂志, 2021, 41(15):1190-1194.
	He FK, Guan XJ, Zhu YH. Clinical research and treatment strategy of acute pulmonary edema[J]. Int J Respir, 2021, 41(15):1190-1194.
[20]	赵昭. 脓毒性休克患者SOFA评分、APACHEⅡ评分、血乳酸水平变化及临床意义[J]. 中国卫生工程学, 2024, 23(6):851-853.
	Zhao Z. Changes and clinical significance of SOFA score,APACHE II score,and blood lactate level in patients with septic shock[J]. Chin J of Public Health Eng, 2024, 23(6):851-853.
[21]	Espinosa-Almanza CJ, Sanabria-Rodríguez O, Riaño-Forero I, et al. Fluid overload in patients with septic shock and lactate clearance as a therapeutic goal:a retrospective cohort study[J]. Rev Bras Ter Intensiva, 2020, 32(1):99-107.
[22]	Lee SG, Song J, Park DW, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia:a retrospective cohort study according to the Sepsis-3 definitions[J]. Medicine(Baltimore), 2021, 100(7):e24835.
[23]	元文琪, 杨文倩, 严莉娟. 床旁超声及PiCCO引导下液体复苏治疗脓毒性休克的效果及安全性研究[J]. 海南医学, 2024, 35(8):1076-1080.
	Yuan WQ, Yang WQ, Yan LJ. Efficacy and safety of bedside ultrasound-and PiCCO-guided fluid resuscitation in the treatment of septic shock[J]. Hainan Med J, 2024, 35(8):1076-1080.
[24]	汪晖, 黄素芳, 熊杰, 等. ICU护士对危重症患者液体复苏管理的知信行现状调查[J]. 中华急危重症护理杂志, 2021, 2(5):405-411.
	Wang H, Huang SF, Xiong J, et al. Investigation on ICU nurses’ knowledge,attitude and practice of fluid resuscitation management in critically ill patients[J]. Chin J Crit Care Nurs, 2021, 2(5):405-411.